Safer Sign Out for Emergency Physicians

Introduction for Implementation

Emergency Medicine Patient Safety Foundation

“Sign out is the most dangerous procedure in the Emergency Department”

Charles “Chaz” Schoenfeld, MD

(1950-2010)

• High RISK process (Highly variable practice)

• Emergency Medicine particular vulnerable

• Standardized method

• Lower variability & predictable process

• Focuses on areas at risk for errors

• Joint Commission recommendation (National Patient Safety Goal 2E)

Why Standardize Sign Out?

• Method for formalizing the patient sign out for ED physicians

• Provides a proven, reliable structure for “handing off” ED patients

• Developed using recommendations from:

• Joint Commission

• American College of Emergency Physicians (Quality Improvement & Patient Safety Section)

• Expert consensus

• Clinician feedback

What is Safer Sign Out?

Up to 80% of serious medical errors involve miscommunication during handoffs (Solet et al 2005)

Up to 24% of ED malpractice claims involve faulty handoffs (Cheung et al 2010)

Typical verbal with note-taking style handoffs had high rates of data loss (D. Pothier, et al 2005)

Written form with verbal exchange = > minimal data loss (D. Pothier, et al 2005)

What’s the Data?

5 Key Steps - “5 Rs”

1) Record - Patient & essential data / updates / pending items

2) Review - Form & computer data

3) Round – Bedside, together

4) Relay to the Team – Inform the nurse/team

5) Receive Feedback – Clinical Outcome & SSO Feedback

Inform the patient prior to the sign out (if possible)

Gives the patient an opportunity to be updated & ask questions

May save time for your colleague

Potential for an improved transition

Record with a Sign Out Form

Hand written or computer generated

Identifies the patient Clear transfer of responsibility

Prompts physician to identify: • Pertinent active issues

• Pending items

• Potential safety issues

Serves as a checklist, reference & reminder tool

Review the Sign Out Form & Computer Data

Done at a computer Access to lab/rad results

Purposeful time for Q & A Assures shared understanding

Minimize interruptions

Bedside Round - Together

“Eyes on the patient” • Patient status

• Monitor reading

Introduction of new doctor • Patient satisfaction

• Process updates

Team communication Include or inform the nurse (relay)

Inform the nurse of transition & important updates • Opportunity for nurse input &

feedback

• Assures team understanding

• Done during or after rounds

Utilize the sign out form as a feedback tool

Receiving physician records outcome • Patient disposition, updates

Form placed in mailbox of off-going physician

(if HIPPA Compliant)

Copy can be used for monitoring the process/QA

Educational Slide Sets

Educational Posters

Sign Out Forms

FAQs

Tools for ABEM MOC use

Educational Videos (pending)

Quality Improvement & Patient Safety Section Website

First Featured Safety Project

• Build the case for standardizing

• Download tools from ACEP QIPS

• Enlist “Champions” to assist

• Be clear on expectations

• Be consistent with utilization

“All active ED Patients”

Encourage Team based approach

Include the nurse

Monitor the process

Calvert Memorial Hospital, Prince Frederick, MD Carroll Hospital Center, Westminster, MD Civista Medical Center, La Plata, MD Washington Adventist Hospital, Takoma Park, MD Montgomery General Hospital, Olney, MD Sibley Memorial Hospital, Washington, DC Inova Alexandria Hospital, Alexandria, VA Prince William Hospital, Manassas, VA Reston Hospital Center, Reston, VA Virginia Hospital Center, Arlington, VA Heathcote Health Center, Haymarket, VA Jefferson Memorial Hospital, WVA

Initial Safer Sign Out Sites

SSO Development Team

Don Infeld, MD (President)

Jackie Pollock, CEO

Nicole Bergen, Dir. of Operations

Martin Brown, MD, (CMO)

John Schnabel, MD

Tim Hsu, MD

Richard Ferraro, MD

Karla Lacayo, MD

Cameron Cushing, MD

Michael Kerr, MD

Steven Smith, MD

David Jacobs, MD

Jennifer Abele, MD

Drew White, MD, MBA

Michael Silverman, MD

Justin Green, MD

Napoleon Magpantay, MD

Kurt Rodney, MD

Sora Chung, MD

Matt Sasser, MD

Jon D’Souza, MD

Todd Larson, MD

Junior Williams, MD

Larry Mack-Wilson, PA-C

Eric Parvis, MD

Drew Fuller, MD, MPH

Kilole Kanno, MD

Dickson Cheung, Jack Kelly and the

ACEP QIPS working group on Improving Handoffs

Emergency Medicine Associates, PA, PC

Germantown, Maryland

EMA Safety Leadership Group

Physicians and Leadership at Calvert Memorial Hospital

Prince Fredrick, Maryland

Drew Fuller, MD, MPH, FACEP Strategic Coordinator for Patient Safety

Emergency Medicine Associates, PA, PC

20010 Century Blvd, Suite 200

Germantown, Maryland 20874

Drewfuller@mac.com

Further Information